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Clinical Psychology > eating disorders REVISE > Flashcards

eating disorders REVISE Flashcards

1
Q

are eating disorders historical or a relatively new phenomenon?

A

occured in the past but categorised as other issues:

  1. renaissance - dying of a broken heart
  2. taking religious orders of only bread and water or just water
  3. first case of western eating disorder was a male
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2
Q

what are the 4 (potentially 5) types of eating disorders?

A 
according to DSM5:
Anorexia Nervosa (AN)

Bulimia Nervosa (BN)

Eating Disorder Not Otherwise Specified (EDNOS) but now Other Specificied Feeding and Eating Disorder

Binge Eating Disorder (linked to normal or over weight)

(obesity?) but would be around 2/3 of population so huge crisis if added to list

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3
Q

what are the 2 main sub-types of eating disorders?

A

anorexia and bulimia

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4
Q

characteristics of anorexia nervosa?

diagnostic criteria in DSM5?
4.

diagnostic issues in DSM4?

A

DSM5
1. refusal to maintain body weight (self-starvation) so at least 15% below normal weight

  1. restricting or binge/purge
  2. intense fear of weight gain (not reduced by weight loss)
  3. distorted body image
DSM4
amenorrhoea (loss of periods but taken out as doesn't happen to men and periods may stop for other reasons)

used to be BMI below 18.5 (drinking a litre of water will bring you above threshold as 1kg but not recovered)

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5
Q

characteristics of bulimia nervosa?

A

loss of control over eating (2 hours) and eat an excessive amount (binge) then purge (vomiting/laxatives/diet pills/exercising)

fear of gaining weight (same as anorexia)

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6
Q

effective treatments of anorexia nervosa?

A

¬ food - side effect of feeling terrible (short term treatment)

¬ family-based interventions (most effective)
structured family meals
meal plans
family therapy

¬ no NICE improved ‘first line’ treatment

¬ MANTRA manualised treatment for adults e.g meal management

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7
Q

effective treatment for bulimic nervosa?

A

CBT-E (extended form of CBT) seems to be effective
very Behavioural
sitting with person and helping them find a way to eat (let cognitive processes catch up)
20 or 40 session model (a lot)

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8
Q

effective treatment for Binge Eating Disorder?

A

not known what even causes binges so no knowledge of how to treat

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9
Q

what percentage of females aged 15 have issues with their body image?

and why do only a small % of those develop an eating disorder?

A

in 90s%
in western media based society
been getting worse especially due to social media

may be another risk factor than body dissatisfaction alone

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10
Q

have eating disorders always been with us cross-culturally or just western concept?

A

fiji before and after television (body dissatisfaction 35%-85%) due to introduction of psychosocial stressor (social cultural component)

bolder, colorado fitness based and so high level of eating disorders

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11
Q

if eating disorders genetic why have they been continually passed down in evolution?

A

adaptation to flea famine hypothesis - can operate on low body weight and think straight and lead rest of people to food and water sources (advantage)

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12
Q

what is orthorexia?

A

obessession with eating ‘healthy’ foods

not officially classified as an ED

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13
Q

what are OSFEDs and examples?

A

umbrella term for several disordered eating behaviours which don’t meet criteria for a specific eating disorder

e.g
body dysmorphic disorder
orthorexia

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14
Q

difference between DSM and ICD?

A

DSM5 american diagnostic system (apa) but UK increasingly using it (NICE guidance based on it)
just mental health, psychology and psychiatry

ICD10 all diseases not just mental health
international

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15
Q

difference between psychology and psychiatry?

A

psychology - broader view of human health and wellbeing
know more about psychology than medics

psychiatry - branch of medicine based on ‘ill-health’ and diseases
do medical degree first

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16
Q

do you need a diagnosis to get access to mental health treatment?

A

yes

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17
Q

risk factors at birth/infancy?

gender
genetics
feeding
parenting style

A

being female (different biologically and psychosocial pressures)

genetic in adolescence - 1st degree relative then 10x more likely to have AN and MZs higher concordance than DZs

early feeding difficulties (fussy)

high concern parenting - child never gets to experience hunger as so highly attuned to child

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18
Q

childhood risk factors?

A

childhood obesity - restricting and bulimic disorders

sexual abuse/neglect

OCPD - obessions around food

childhood anxiety disorders

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19
Q

risk factors in adolescence?

A

being an adolescent as when they tend to emerge

body dysmorphic disorder

high level exercise (jockeys, dancers, runners i.e any weight threshold)

dieting positively reinforced by sense of mastery and self-control

OCD/perfectionism

negative self-evaluation

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20
Q

what are the 5 factors clinicians look for to understand how to treat their patient with an ED?

A 
predisposing factors
precipitating factors
presenting factors
perpetuating factors
protective factors
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21
Q

bio-psycho-social model as a cause of eating disorders

predisposing
precipitating
perpetuating

A

predisposing factors - epigenetics, genetics, brain and socio-cultural context which turns these factors into a vulnerability

precipitating factors - puberty (hormoal, social etc.), dieting and stress/trauma

perpetuating factors - management by parents and clinicians, trauma and stress, some perceived advantages so maintaining it e.g reduced stress when not eating

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22
Q

why may CBT not be the most effective treatment for eating disorders?

but how widely is it used

A

major cause could be due to neurobiological abnormalities causing different neuropsychological processing styles so not just the ‘here and now’ to treat

but CBT is the main form of psychological therpay for all the eating disorders and the most effective

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23
Q

what % do we know about the brain?

A

around 1%

24
Q

neurobiological abnormalities?

A

abnormality persists even after recovery

left sided hypoperfusion (reduction in activity and blood flow) centered on insula which deals with hunger, body image and disgust
70% of patients have functional abnormality in insula network

if abnormality in brain due to starving the body, would expect reduced activity in all areas not just e.g insula

25
Q

what is an example of a neuropsychologically informed treatment for eating disorders?

A

cognitive remediation therapy

not addressing what you think (processes) but how you think (content)

give homework to e.g try and be flexible at home and do something different

26
Q

role of noradrenaline in eating behaviour?

positive and negative reinforcement

A

starving = shortage of noradrenaline which = decrease in stress levels SO reinforces the starving behaviour

nordrenaline receptors become supersensitive
SO when person eats, these receptors are flooded with noradrenaline = increase in stress levels = negatively reinforced

reinforces negative view of food side effect that it makes them feel terrible

27
Q

relation between diet coke and those with eating disorders?

A

many drink it, presumed due to being ‘diet’
may be due to the fact it contains tyrasine, which contains dopamine, which contains nordadrenaline so person is unknowingly self-medicating

28
Q

which 3 networks are the focus of medication?

A 
norderenaline
dopamine (reward network)
seronergic network (depressive)
29
Q

relationship between buddhist monks and the insula network?

A

as a result of meditating for 8 hours a day for 30 years, their insula networks are larger as they practice body mapping daily

30
Q

what are buddhist monks and real time fMRIs examples of?

A

neurobiofeedback

31
Q

what is real time fMRI?

A

showing or telling a person their current insula activation and asking them to make it higher/lower by changing blood flow to insula

if healthy can learn to modulate in about 5 mins even though they don’t know how

32
Q

neuropsychological processing styles found in people with eating disorders:

issues with visual spatial processing

A

have problems with visual spatial processing
related to insula network

creates difference between how they see their body and how they feel about their body

33
Q

neuropsychological processing styles found in people with eating disorders:

central coherence

A

inability to integrate global processing and detailed thinking
(seeing both the wood and the tree), only detailed thinking

34
Q

neuropsychological processing styles found in people with eating disorders:

cognitive flexibility

A

problems with shifting between different ways of thinking so stuck in ritualistic thoughts

35
Q

neuropsychological processing styles found in people with eating disorders:

risk / reward processing problems

A

ability to identify risky choices and avoid impulsive responses
impaired

36
Q

neuropsychological processing styles found in people with eating disorders:

problems with emotion processing

A

issues in turning emotions into feelings

e.g
alexithymia - lacking words for feelings so makes psychotherapy difficult

37
Q

what is formulation and what is the model that goes alongside it?

A

working out which risk factors may be relevant and organising thinking (clinician)

the 5 P model

38
Q

the 5 P model

what are predisposing factors?

A

predisposing risk factors in infancy e.g genetics, epigenetics and socio-cultural environment

39
Q

the 5 P model

what are precipitating factors?

A

what got the ED started e.g depressive episode or traumatic event or dieting
and when first aware that they had it

40
Q

the 5 P model

what are presenting factors?

A

rich description of what’s going on and what it means to them e.g describe typical day

41
Q

the 5 P model

what are perpetuating factors?

A

what’s maintaining the ED (often very different reason for why it started) and able to establish through presenting factors

deal with here and now

42
Q

the 5 P model

what are protective factors?

A

what assets/social support have you got that can help you recover
need message of hope

43
Q

why is it hard to treat prepubertal 8-10 year olds with AN?

A

they are unaware why they have the disorder as can’t articulate it
just that restrcting
works for them

44
Q

typically, who does the public blame for eating disorders?

A

the person who has the disorder as sees them as deliberately ‘self-destructive’ and ‘attention-seeking’

45
Q

what is the meaning behind ‘anorexia’ and ‘nervosa’?

A

anorexia - loss of appetite (but majority of people don’t actual lose their appetite)
nervosa - loss due to emotional reasons

46
Q

what is the lifetime prevalence of anorexia and ratio of men to women with it?

A

less than 1%

10:1 to women

47
Q

suicide rates for anorexia?

A

5% complete

20% attempt

48
Q

what are the physical consequences of anorexia?

A

change in hormone levels
heart rate slows
blood pressure falls

49
Q

what is the prognosis for those with anorexia?

A

between 50-70% recover but takes 6-7 years

mortality rates for women are 3-5% (due to suicide and physical complications due to illness)

50
Q

prevalence of bulimia?

mortality rate?

A

around 1-2% of women

mortality rate nearly 4%

51
Q

what are the physical consequences of bulimia?

A

amenorrhea
irregular heart rate
loss of enamel and tearing of stomach tissue due to vomiting

52
Q

prognosis of bulimia?

A

75% recover

53
Q

what are the characteristics of binge eating disorder?

what makes it distinct from both anorexia and bulimia?

A

recurrent binges -
once a week over 3 months to be diagnosed

distress over binges

lack of control during bingeing episodes

most often obese people (BMI<30)

not anorexia - no weight loss and not restrictive as lose control
not bulimia - no compensatory behaviours e.g vomiting

54
Q

prevalence of binge eating disorder?

A

2% for men and 3.5% for women

55
Q

physical consequences of binge eating disorder?

A

IBS
sleep problems
mood disorders

56
Q

medication as a treatment for eating disorders

A

bulimia - treated with antidepressants as highly comorbid with depression
BUT high dropout due to side effects and high relapse rate when finish treatment

anorexia - not been successful in improving weight or anything else

57
Q

family therapy as a treatment

A

interpersonal problem not individual problem

bring family conflict to the fore instead of avoiding it

helping eating disorder brings family closer

Clinical Psychology (15 decks)

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